Simulation training for gynecologic surgery

Key Points

A paradigm shift is under way in the field of surgical education, with a transition away from the traditional apprenticeship model of medical training. The new surgical teaching model includes learning basic surgical skills, practicing on a model, watching videos and observing in the operating room, and performing a surgical procedure with feedback and evaluation.¹ Simulation training has emerged as an alternate modality to augment traditional surgical training.

The growth of simulation for gynecologic surgical training took its roots within residency programs in response to a decrease in patient availability for training. The decline in training opportunities resulted from several factors, including work-hour restrictions, increased subspecialization, growth of minimally invasive options, and financial and professional liability concerns. Since the advent of work-hour restrictions, there has been a decline in the total number of surgical cases for graduates of residency training programs. Furthermore, the practice of gynecology has evolved. With the advent of more interventional radiologic procedures and effective medical therapies, conditions that were previously treated surgically are now managed conservatively, further reducing the number of available cases for surgical training.

The growth of minimally invasive and robotic surgery provides opportunities for less experienced surgeons to acquire knowledge. An increase in pelvic reconstructive surgery fellowships and advanced training programs in minimally invasive surgery has created competition among residents, fellows, and less experienced surgeons to acquire enough patients for training. In addition, the decrease in patient availability for training also may be a consequence of an increased emphasis on patient safety initiatives and cost efficacy in training.